The premenstrual syndrome – a reappraisal of the concept and the evidence

Abstract

Request Permissions : Click here Downloaded from http://journals.cambridge.org/PMS, IP address: 216.165.126.139 on 12 Apr 2015 SYNOPSIS The Premenstrual Syndrome (PMS) remains a controversial issue. As a clinical concept it is surrounded by confusion. Attempts to establish a consensus definition have resulted in the majority of women seeking help for such problems excluded from the diagnosis. Furthermore, there is no consensus about how such problems should be treated, with a variety of methods being advocated usually on very uncertain scientific grounds. The issue also has its political implications; there are those who see PMS as a way of reducing the status of women, by linking the normal ovarian cycle to a phenomenon which, on the face of it, impairs women's ability to cope. Yet there are a substantial number of women who experience significant negative changes which vary with the menstrual cycle, and produce long-term effects on their well being and family relationship which can be serious. There is also a real possibility that recurrent perimenstrual mood changes of this kind may increase the likelihood of chronic depressive illness in susceptible individuals. In most respects the features of depression which occurs perimenstrually are essentially similar to those of major depressive disorder, except for the short duration and recurrent pattern.PMS, therefore, remains an issue not only of clinical importance, but of considerable potential relevance to our understanding of major depressive disorder, which is substantially more common in women of reproductive age than in their male counterparts.In this review the concept of PMS, and some prominent operational definitions of it, are critically evaluated; it is now questionable whether the concept, as currently applied, still carries any heuristic or clinical value. Some current theoretical and aetiological issues are considered: e.g. the role of the corpus luteum, the effects of hormonal regimes which block ovulation, such as oral contraceptives, and the possibility that cyclical mood change represents an entrained rhythm in the brain.The conclusions reached at this stage in the review lead to a ' paradigm shift' with the proposal of a three-factor model to account for the complexities of menstrual cycle-related problems. These three factors are (a) the 'timing factor', imposed by the ovarian hormonal cycle, and possibly accounting for cyclical changes in CNS neurotransmitter activity; (b) a 'menstruation factor', including the processes involved in the build up as well as shedding of the endometrium and the ways in which these processes might adversely affect the women's well being both premenstrually as well as during menstruation; and (c) the 'vulnerability factor', covering a variety of characteristics, constitutional as well as situational, psychosocial as well as biological, which are not in themselves functions of the menstrual cycle but which serve to determine how vulnerable a woman will be to the first two factors.The relevant evidence in the litera...

Sensitivity to CCK-4 in Women with and without Premenstrual Dysphoric Disorder (PMDD) During Their Follicular and Luteal Phases

“…All tests performed in Table 2 not a surprising find. It is consistent with the results obtained in other biological challenge studies of PMDD women (Bancroft et al 1991;Harrison et al 1989) and leads us to the state-versus-trait issue (Bancroft 1993), which needs to be addressed in future investigations. The differences in behavioral and physiological responses between placebo and CCK-4 injections in healthy volunteers are consistent with those already discussed in many studies (Bradwejn et al 1991;De Montigny 1989;Jerabek et al 1995).…”

The epidemiology of perimenstrual psychological symptoms

“…The tension between severity and subjective distress in de®ning a disorder is apparent for PMDD since only a small proportion of those women with premenstrual and menstrual psychological symptoms meet criteria, yet a large proportion of these women report that they have sought treatment or taken medication for pre-or perimenstrual symptoms (11). In his comprehensive review of this syndrome, Bancroft (12) suggested that a broader conceptualization of symptoms associated with the menstrual period including both the premenstrual and menstrual phase would provide a more valid representation of the evidence. None the less, there is some agreement that the terms PMDD and severe PMS are so often used interchangeably that they are likely to belong to the same disorder spectrum (13).…”

Premenstrual Syndrome Prevalence and Fluctuation over Time: Results from a French Population-Based Survey

“…Bancroft 15 summarized the PMS risk factor profile as including a timing factor (controlled by neurotransmitters), a menstruation factor (involving physiological changes preceding menses), and a vulnerability factor (involving personality, predisposition to depression, attitude toward menstruation). However, as much of the previous work on PMS risk factors has been conducted on clinically derived cohorts, it is yet unknown how this risk factor profile applies to the general population.…”